The
Senior Clinical Admin Nurse checks for validity, accuracy, and completeness of comprehensive clinical assessments
Ensuring that the field clinicians comply with all applicable State and Federal regulations and consent decrees, as well as the applicable accrediting regulatory review agencies, including but not limited to CMS, NCQA, HIPAA, and all UHC policies and procedures as applicable
- Reviews clinical data on Minimum Data Set – Home Care Assessment (MDS HC) to determine compliance with level of care contractual and regulatory requirements of the State Medicaid programs, prior to submission to the MMIS state system
- Verifies and reviews for efficiencies and effectiveness of procedures
- Maintains timely and accurate submission into the MMIS state application
- Performs internal Quality Control reviews on processes and activities while developing recommendations for improvement
- Serves as a catalyst for identifying and implementing process improvements designed to identify and correct deficiencies
- Assists with the coordination of internal/external audits and reviews
- Maintain extensive knowledge of regulatory and applicable accrediting body requirements becoming a Compliance resource for the team
- Proficient in interpreting clinical notes and assessments completed by field nurses
- Interact effectively with field clinicians and other departments
- Establish and maintain good working relationships throughout the company to support goals and objectives
- Demonstrate flexibility, availability, and dependability to conform to conform to position responsibilities
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach. This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
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